Active NPI
Joseph Edward Gottesman, PH.D.
- Clinical Psychologist
- Dix Hills, NY
National Provider Identifier
1588280473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 017525
- Practice address
- 6 Tara LN
Dix Hills, NY 11746-7133 - Phone
- (516) 642-9374
- Fax
- (631) 940-7691
- NPI assigned
- Jun 17, 2020
- Last updated
- Jun 17, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 017525 | NY | Primary |
Addresses
Primary practice location
6 Tara LN
Dix Hills, NY 11746-7133
Mailing address
6 Tara LN
Dix Hills, NY 11746-7133
Phone (516) 642-9374
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017525 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592352000000",
"number": "1588280473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 TARA LN",
"city": "DIX HILLS",
"state": "NY",
"postal_code": "117467133",
"telephone_number": "516-642-9374",
"fax_number": "631-940-7691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 TARA LN",
"city": "DIX HILLS",
"state": "NY",
"postal_code": "117467133",
"telephone_number": "516-642-9374",
"fax_number": "631-940-7691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOTTESMAN",
"first_name": "JOSEPH",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-06-17",
"last_updated": "2020-06-17",
"certification_date": "2020-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "017525",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dix Hills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.